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5.2 Services, Benefits, Limitations and Prior Authorization
Genetic services may be used to diagnose a condition, optimize disease treatment, predict future disease risk, and prevent adverse drug response. Genetic services may be provided by a physician, physician assistant, nurse practitioner, or clinical nurse specialist and typically include one or more of the following:
• Comprehensive physical exams
•Diagnosis, management, and treatment for clients with genetically-related health problems
•Evaluation of family histories for the client and the client's family members
•Genetic risk assessment
•Genetic laboratory tests
•Interpretation and evaluation of laboratory test results
•Education and counseling of clients, their families, and other medical professionals on the causes of genetic disorders
•Consultation with other medical professionals to provide treatment
Pharmacogenetics encompasses the use of information encoded in clients' DNA to help predict their responses to medicines and to enhance the effectiveness and safety of medicines for individual clients. Testing for drug efficacy is not a benefit of Texas Medicaid.
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